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Tumour dosimetry and response in patients with metastatic differentiated thyroid cancer using recombinant human thyrotropin before radioiodine therapy

European Journal of Nuclear Medicine and Molecular Imaging volume 30, pages 367–373 (2003)Cite this article

Abstract

The development of recombinant human thyrotropin (rhTSH) has given clinicians new options for diagnostic follow-up and treatment of patients with differentiated thyroid cancer (DTC). This paper evaluates the tumour dosimetry and response following -iodine-131 treatment of metastatic thyroid cancer patients after rhTSH stimulation instead of classical hormone withdrawal-induced hypothyroidism. Nineteen consecutive 131I treatments in 16 patients were performed after rhTSH stimulation. All patients had undergone a near-total thyroidectomy followed by an ablative dosage of 131I. They all suffered from metastatic or recurrent disease showing tumoral 131I uptake on previous post-treatment scintigraphy. Dosimetric calculations were performed using 131I tumour uptake measurements from post-treatment 131I scintigrams and tumour volume estimations from radiological images. Response was assessed by comparing pre-treatment serum thyroglobulin (Tg) level with the Tg level 3 months post treatment. In 18 out of 19 treatments, uptake of 131I in metastatic or recurrent lesions was seen. The median tumour radiation dose was 26.3 Gy (range 1.3–368 Gy), and the median effective half-life was 2.7 days (range 0.5–6.5 days). Eleven of 19 treatments (10/16 patients) were evaluable for response after 3 months. 131I therapy with rhTSH resulted in a biochemical partial response in 3/11 or 27% of treatments (two patients), biochemical stable disease in 2/11 or 18% of treatments and biochemical progressive disease in 6/11 or 55% of treatments. Our study showed that although tumour doses in DTC patients treated with 131I after rhTSH were highly variable, 45% of treatments led to disease stabilisation or partial remission when using rhTSH in conjunction with 131I therapy, without serious side-effects and with minimal impact on quality of life. RhTSH is therefore adequately satisfactory as an adjuvant tool in therapeutic settings and is especially suitable in advanced recurrent or metastatic DTC patients who may be intolerant to TSH stimulation by levothyroxine withdrawal.

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Fig. 1. A

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Acknowledgements

This work was supported in part by Genzyme B.V. Netherlands, Naarden, The Netherlands. We are grateful to Eilis Haughian for her valuable suggestions. We thank Hans van Asselt for his excellent technical assistance.

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Affiliations

  1. Department of Nuclear Medicine, Room E02.222, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands

    Bart de Keizer, Anne Hoekstra, Peter P. van Rijk & John M. H. de Klerk

  2. Department of Nuclear Medicine, Ghent University Hospital, Ghent, Belgium

    Boudewijn Brans & Rudi A. Dierckx

  3. Department of Endocrinology, University Medical Center Utrecht, The Netherlands

    Pierre M. J. Zelissen, Hans P. F. Koppeschaar & Cees J. M. Lips

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  1. Bart de Keizer
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  2. Boudewijn Brans
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  3. Anne Hoekstra
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  4. Pierre M. J. Zelissen
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  5. Hans P. F. Koppeschaar
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  6. Cees J. M. Lips
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  7. Peter P. van Rijk
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  8. Rudi A. Dierckx
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  9. John M. H. de Klerk
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Correspondence to Bart de Keizer.

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de Keizer, B., Brans, B., Hoekstra, A. et al. Tumour dosimetry and response in patients with metastatic differentiated thyroid cancer using recombinant human thyrotropin before radioiodine therapy. Eur J Nucl Med 30, 367–373 (2003). https://doi.org/10.1007/s00259-002-1076-y

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  • DOI: https://doi.org/10.1007/s00259-002-1076-y

Keywords

  • Differentiated thyroid cancer
  • rhTSH
  • Dosimetry